A nutritional risk index-based nomogram for predicting prognosis and identifying induction chemotherapy beneficiaries...

This study was designed to assess the prognostic significance of nutritional risk index (NRI) in nasopharyngeal carcinoma (NPC) patients. In this dual-center study, 1,174 patients were enrolled. Kaplan-Meier analysis assessed the association between NRI and prognosis. Independent prognostic factors for nomogram construction were identified using multivariate Cox regression analysis. The predictive nomogram underwent assessment through decision curve analysis (DCA) and calibration curves. The median NRI value was 112.11. Patients with high NRI (≥ 112.11) demonstrated significantly better survival outcomes than those with low NRI (< 112.11) in both cohorts. Multivariate analysis identified that NRI (≥ 112.11 vs. < 112.11) was an independent prognostic factor for distant metastasis-free survival in the training cohort, and for overall survival (OS) and locoregional relapse-free survival in the validation cohort. The constructed nomogram showed strong discriminatory ability (C-index: 0.715 for training; 0.678 for validation) and good calibration. DCA indicated superior clinical net benefit compared to default strategies. Risk stratification revealed that low-risk patients achieved significantly higher 3-year OS (97.8% vs. 81.1%, P < 0.001) and progression-free survival (PFS, 93.0% vs. 69.3%, P < 0.001) than high-risk patients. Within the high-risk group, the induction chemotherapy (IC) plus radiotherapy (RT)/concurrent chemoradiotherapy (CCRT) regimen significantly improved OS and PFS compared to RT/CCRT alone. Among low-risk patients, the two regimens yielded comparable outcomes. The NRI serves as a reliable prognostic indicator for NPC patients. The proposed nomogram enables personalized risk stratification and offers reference for individual treatment regimen selection.